Friday, September 11, 2009

Biblical Plagues

Absent I have been.

Two weeks ago my inlaws came a calling from halfway cross the country and indulged their grandchildren for a week or so. It kept us all busy. It was a good thing, though there was an undercurrent of dread because once they returned home my mother-in-law was set to undergo a procedure to see why she kept having blood in her urine as well as abnormal cells. Kidney stones could account for part of it, but you never know.

During their visit my father-in-law took a small fall in his hotel room. His hand felt numb for the rest of the week as a result. I assumed he had injured his wrist much as I had last year.

Once they got back, his hand began to hurt and a visit to his doc got to the root of it - he had suffered a stroke. The fall was not just a stumble and the hand was a consequence of dead brain cells. He has lost peripheral vision as well, but the pain in the hand indicates that feeling will return to it.

Meanwhile, the procedure on mom-in-law revealed no masses, but biopsies were taken to make certain that the big "C" is not present.

The final night of their visit with us I prepared a major grilling feast, but halfway through the cooking I was overwhelmed by pain in my back and flank. Long story short - I spent the following week enduring a kidney stone myself. Been there, done that, hoped I wouldn't ever again, but that's life.

Towards the end of my stony adventure last week, my wife, the Girl, and the Baby all developed a mild cold that seemed to be gender-specific as neither I nor the Boy were nailed by it. It wasn't a bad bug, but the Girl developed a decent fever on Sunday night. On Monday the fever seemed to be getting higher and by Tuesday she was spiking around 103 or above. It was unusual because neither my wife nor the Baby were showing any fever. Tuesday night my wife returned from work around 10pm and we heard the Girl crying in her room. When we got her up she was hot - really hot. Thermometer said 105.4. Back to the hospital goes my wife with the ember-like Girl in tow. Two hours later my wife texts me from the ER that they have done a rapid strep test and a test for influenza A and B - all of them negative. The ER doc says its just a bug, nothing to worry about, let it run its course, don't sweat the fevers, and sends her home. I say, "HUH?!"

The next day the Girl hits 104.8 and I yell bullshit. I call our pediatrician and get her in that afternoon. They take blood. They take a chest x-ray (pneumonia in infants and toddlers will often present with no signs at all except fever). They catheterize her (that's a delight) and take urine. They swab her throat for a standard strep test. While we wait in the exam room for results she starts to spike another fever and begins panting in my arms. Doc returns and says it appears to be a urinary tract infection - there's blood, white cells and bacteria in her urine. A massive injection of Rocephin is given as well as ibuprofen to knock the fever down. An appointment is scheduled for the next day to get the results of the culture. The Girl spends the night riding a roller coaster of fever.

I return the next day, feverish Girl in my arms, and am told that the tests have confirmed it all, but it's actually worse. She has a kidney infection - Pyelonephritis. It is massive, active and aggressive. This is bad. It is only because she is hydrating that she is not being admitted to the hospital. She is given another painful injection of Rocephin (the shot hurts so much they add lidocaine to it to ease the suffering). I am to call today to get the bacterial sensitivity results and the appropriate antibiotic to kill it. After the infection clears up tests are scheduled to look for a congenital defect - possibly vesicoureteral reflux - that may have caused this. She will undergo more catheterization, dyes, radioactive liquids and general misery. If the tests prove positive for a defect she will either go through daily antibiotics until it resolves itself - potentially years - or if it's severe she will require surgery.

In the discussion with our pediatrician yesterday I asked why this slipped through the ER. Our doc is about the calmest person I have ever met - like a still pond - and that's why we like her. But she was angry. If we had followed the ER advice and been average parents we might not have called about it til today or even next Monday. Doc put it simply: if we had waited another day to call, our daughter would be in the hospital; two days, she could have lost her kidney; called on Friday or Monday, well, you can't dial the phone with a dead child in your arms.

A UTI should have been looked for in the ER. A urine test should have been performed. It was discounted because Dr. Emergency tapped on her abdomen and the Girl didn't say "Ow." I might point out that she didn't say "ow" in the pediatrician's office either but that didn't stop our doctor from doing her job.

Our Doc wants us to make a stink. She says this isn't the first time she has seen callous negligence in that ER and it won't be long before somebody dies.

Kids get high fevers - very high, the highest they will likely have in their lives - but the textbook says if it hits 105, there is something dangerously wrong and a cause MUST be pinpointed and treated. No ifs, ands, or buts. Some idiot damn near killed my daughter. She still may have suffered permanent kidney damage because of his incompetence. My fury at this moment is exceeded only by my concern for the Girl's recovery.

Our recent Biblical plague is about to be replaced by some good old-fashioned Biblical wrath.

Related medical provider incompetence addendum:

I had a follow-up appointment scheduled today with my doc regarding my kidney stones. Last week he had said he wanted a spiral CT scan to check for damage in me. He would get it approved and scheduled, let me know, and the appointment today would review the results. I never got a call telling me when the scan was scheduled. Appointments can take some time, and the Girl's issues kept me occupied anyway. Last night my wife got an automated call reminding me of my appointment today. I called this morning to remind them I still hadn't had the scan. I was transferred to the office referral guy. After I explained he said he would get back to me. He called again while I was out and asked my wife how to spell my name. Uh oh. I called him back and after twenty minutes on hold (seriously) I spoke to him. He told me he was working on the scan appointment. I asked him if the doc had failed to let him know. He chuckled with embarassement and said, "No, I had it. I'm just backed up on my paperwork, but I'm trying to get the scan for you today."

I said, "Um, I can't do it today."

"But I thought you had an appointment with the doctor today?"

"I did - an hour ago," says I.

"Well I thought this scan was important," he counters judgementally.

"It is important. Just like it was important a week ago when you got the paperwork," I retort less than graciously. "Just schedule it next week sometime," I tell him.